Plastic Surgery Weekly

Retrospective analysis of 580 consecutive patients undergoing free fibula mandibular reconstruction between 2018 and 2024, comparing those who developed plate exposure with those who did not and evaluating an osteotomy modification that rotates the fibular segment to position flexor hallucis longus over hardware.

• Adequate muscle coverage was present in 97.02% of patients without plate exposure versus 33.33% of those with exposure (p<0.0001).
• Among patients receiving postoperative radiotherapy, adequate coverage rates were 96.34% in the non-exposure group versus 50% in the exposure group (p=0.001).
• Multivariate analysis confirmed inadequate muscle coverage as an independent predictor of plate exposure (OR 22.67, 95% CI 3.79 to 135.60).

Single-institution retrospective cohort of 55 pediatric patients (57 fibula flaps) with open physes harvested between 1997 and 2024, characterising donor-site morbidity stratified by osteoarticular versus standard segmental harvest with a mean 6-year follow-up.

• Among 8 osteoarticular flaps, transient deep peroneal nerve palsy occurred in four, all of whom recovered antigravity dorsiflexion by 6 months.
• In 49 standard segmental harvests, donor-site complications occurred in 38%, most commonly valgus ankle deformity (9%) and neuropathic pain (6%).
• Valgus deformity was more frequent in patients with shorter distal residual fibula and an age-residual fibula index <16.

Two-center retrospective matched cohort of 34 pairs drawn from 821 lower-limb free flap reconstructions performed between 2006 and 2024, comparing patients who underwent significant vascular intervention within 100 days before reconstruction with 1:1-matched controls without prior revascularization.

• Operative time was longer in vasculopathic patients (456 vs 364 min, p=0.003), while flap success was 88.2% versus 100% (p=0.13).
• All four flap losses occurred when microvascular anastomoses were performed on the previously intervened vessel, corresponding to a 28.6% failure rate in that subgroup (p<0.03).
• Limb salvage was achieved in 94.1% of vasculopathic patients, with secondary amputation rates of 5.9% in both arms.

Single-center retrospective case series of 4 patients (4/196 facial reanimations) with absent or compromised recipient vessels undergoing AV loop-assisted free functional gracilis transfer between 2010 and 2025, with age-matched conventional FFGT controls used to contextualize operative and ischemia times.

• No AV-loop thrombosis, flap loss, hematoma, wound complication, or donor-site morbidity occurred over a mean follow-up of 19.3 months.
• Compared with age-matched FFGT controls, operative times were prolonged while ischemia times remained comparable.
• Functional smile restoration was achieved in two of four patients within 12 months.

Cross-sectional patient-reported outcomes survey of 152 individuals (64% response rate) at a median of 3.4 years after gender-affirming mastectomy, evaluating BODY-Q Chest and Nipples scales and GCLS Chest, Psychological Functioning, and Life Satisfaction subscales.

• Median BODY-Q Chest score was 87/100 and BODY-Q Nipples score was 90/100.
• GCLS subscale medians were 5.0/5.0 for Chest, 4.8/5.0 for Psychological Functioning, and 3.9/5.0 for Life Satisfaction.
• Findings extend prior early-postoperative data by documenting durable patient-reported benefit beyond two years from surgery.

Retrospective ACS-NSQIP analysis of 663 patients undergoing gender-affirming vaginoplasty from 2012 to 2022, comparing those discharged within 2 days with those staying longer using propensity-adjusted logistic regression.

• Early-discharge patients had significantly fewer complications (p = 0.03), with non-significant trends toward fewer readmissions (2 vs. 25) and reoperations (4 vs. 25).
• On multivariable analysis, operative time was the only independent predictor of prolonged length of stay.
• Univariate predictors included preoperative hematocrit, operative time, and surgical specialty, and groups also differed by age, race, and ASA classification.

Single-center retrospective review of 40 patients with ballistic mandibular fractures treated between 2020 and 2024 (10 external, 30 internal fixation), with multivariable comparison of complications through 6 months.

• Median operative time was shorter with external fixation (118.5 vs. 194.5 min, p = 0.01).
• Short-term complications were higher after external fixation (80% vs. 33.3%), reflecting greater initial injury severity in that group.
• After definitive fixation, long-term complications fell to 10% with initial external fixation versus 33.3% with primary internal fixation, with a non-significant trend on multivariable analysis (OR 0.113, 95% CI 0.004 to 1.11).

Single-institution prospective cohort of 7 patients with facial nerve paralysis and symptomatic cheek biting who underwent periosteal fixation to elevate the buccal musculature, with patient-reported scores assessed at one year.

• Mean symptom score rose from 25.0 ± 18.9 preoperatively to 78.6 ± 20.8 at one year (p = 0.042).
• Intraoral photographs showed resolution of buccal mucosal protrusion into the occlusal space after surgery.
• The technique was described as minimally invasive and produced an incidental mild smiling appearance from cheek soft-tissue elevation.

Retrospective cohort of 440 patients with Bell's palsy or Ramsay-Hunt syndrome from 2009 to 2025, comparing risk factors and eFACE severity between recurrent or bilateral cases and a nonrecurrent unilateral reference group.

• 6.8% had recurrence and 7.3% had bilateral palsy; age under 40 at onset was associated with recurrence (p = 0.017).
• Autoimmune disease was associated with bilateral involvement (p = 0.030).
• eFACE severity did not differ between recurrent, bilateral, and nonrecurrent unilateral groups, and Bell's palsy and Ramsay-Hunt showed comparable rates of recurrence and bilaterality, with events typically about a decade apart.

Cross-sectional 3D stereophotogrammetry study of 16 patients after Hughes flap repair of full-thickness lower-eyelid defects, comparing operated and contralateral eyes in neutral, manual, and 15.9 g hook-distraction conditions.

• In neutral position, operated eyes showed significantly larger lateral canthal angles and lateral lid distances (p ≤ 0.010).
• Hook distraction produced smaller length and area changes on the operated side (p ≤ 0.023), indicating increased eyelid tension and reduced compliance.
• Differences were more pronounced in defects >50% of eyelid length, with smaller but persistent geometric changes after smaller defects.

Network meta-analysis of 71 studies comparing arthrodesis, trapeziectomy without suspensionplasty/ligament reconstruction (S/LR), trapeziectomy with S/LR, and joint replacement for base-of-thumb arthritis, ranking interventions by SUCRA values for reoperation, VAS pain, Kapandji opposition, and DASH/QuickDASH.

• Trapeziectomy with S/LR ranked best for reoperation risk (SUCRA 98.2%), followed by trapeziectomy without S/LR (66.4%), joint replacement (34.1%), and arthrodesis (1.3%).
• Joint replacement ranked highest for VAS pain (SUCRA 91.7%), Kapandji opposition (88.8%), and DASH/QuickDASH (99.9%).
• Authors concluded that evidence remains insufficient to recommend routine joint replacement, citing the trade-off between modest patient-reported gains and an elevated reoperation signal.

Propensity-matched TriNetX cohort of 97,680 patients (48,840 per arm) undergoing trigger finger release between 2010 and 2025, comparing 90-day ICD-coded complications between single-digit and multiple-digit release.

• Multiple-digit release was associated with higher postoperative pain (1.92% vs 1.00%; RR 1.92, 95% CI 1.72 to 2.14; p<0.001).
• Joint stiffness or contracture was more common after multiple-digit release (6.82% vs 3.03%; RR 2.25, 95% CI 2.12 to 2.39; p<0.001).
• Subsequent flexor tenolysis was more frequent in the multiple-digit cohort (1.06% vs 0.80%; RR 1.32, 95% CI 1.16 to 1.51), and CRPS was rare and observed only in that group (0.04%).

Retrospective review of 84 thumbs (42 arthrodesis, 42 trapeziectomy with suspensionplasty) treated between 2012 and 2024, comparing radiographic correction and functional outcomes stratified by preoperative MCP joint status.

• Arthrodesis corrected MCP hyperextension by addressing CMC flexion deformity while preserving thumb opposition, whereas trapeziectomy did not and even increased MCP extension in non-hyperextended thumbs.
• In thumbs with preoperative MCP hyperextension, trapeziectomy showed no notable gain in grip or pinch strength, while arthrodesis subgroups improved.
• Unadjusted analysis favored arthrodesis for final pinch strength and trapeziectomy for zero reoperations, but procedure was not independently associated with pinch strength after multivariable adjustment.

Single-center retrospective long-term follow-up of 31 patients (37 nerve transfers) at least 5 years post-surgery, combining telephone survey, qualitative interview, BMRC strength testing, and DASH outcomes.

• Among 22 reexamined patients, mean BMRC grade rose from 3.3/5 at 18 months to 4.4/5 at ≥5 years.
• 90.3% of patients reported continued functional recovery beyond the 18-month mark.
• Mean long-term DASH score was 24.7 and 87.1% had resumed work or preinjury activities.

Propensity-matched national administrative database analysis of adults undergoing De Quervain's release, comparing patients who received a corticosteroid injection within 90 days preoperatively with uninjected controls, plus a 60-day sensitivity analysis.

• Patients injected within 90 days before surgery did not have higher rates of surgical-site infection, reoperation for infection, or wound dehiscence.
• A sensitivity analysis at 60 days likewise showed no increase in postoperative infection.
• Propensity matching balanced age, sex, US region, insurance, Elixhauser Comorbidity Index, and tobacco use between cohorts.

Prospective randomized trial of 172 patients undergoing a variety of upper extremity procedures compared tourniquet release before incision closure (n=91) versus after closure (n=81), measuring complications, VAS pain, and QuickDASH at follow-up.

• Demographic data were similar between cohorts, with no intraoperative or immediate postoperative complications requiring intervention in either group.
• Follow-up VAS pain scores were comparable between the two groups, with no meaningful difference attributable to release timing.
• Postoperative QuickDASH scores showed no significant difference between release-before and release-after cohorts.

Retrospective comparative cohort of 44 patients with De Quervain's tenosynovitis underwent open (n=15) or single-portal endoscopic-assisted release (n=29) with mean follow-up of 41 months (range 6-120), assessing VAS, DASH, Mayo wrist score, and grip/pinch strength.

• Both groups demonstrated significant postoperative improvement in VAS pain, DASH, and Mayo wrist scores, with no significant between-group difference.
• Median grip strength reached 94% of the contralateral side in the endoscopic group versus 76% in the open group (p=0.072), a non-significant trend.
• Preoperative baseline characteristics and complication rates were comparable between the two techniques.

Systematic review of 24 published patients (26 nerve injuries) combined with a bi-institutional case series of 6 patients characterized upper limb peripheral nerve injuries associated with subdermal contraceptive implant procedures, including injury distribution, severity, treatment, and recovery.

• Most injuries occurred during implant removal (67%), with the ulnar nerve most frequently affected (52%), followed by median (26%) and medial antebrachial cutaneous nerves (22%).
• Injury severity ranged from neuropraxia (33%) and axonotmesis (26%) to axonotmesis with neuroma-in-continuity (33%) and partial transection (7%), with surgical intervention required in 56% of cases.
• At final follow-up, 39% achieved full recovery, 43% had partial recovery, and 9% had no recovery, with implant impalpability flagged as a key risk factor and image-guided removal proposed as standard.

Systematic review of 10 studies pooling 141 patients with Lichtman stage 2 or 3A Kienböck's disease treated with isolated capitate shortening osteotomy, with mean follow-up of 40.9 months and assessment of VAS, DASH, radiographic progression, and lunate revascularization.

• VAS pain scores improved from a preoperative range of 6.9-8.4 to a postoperative range of 1.4-3.3, and DASH scores improved from 43.7-65.8 preoperatively to 13.5-38.3 postoperatively across reporting studies.
• Disease progression occurred at an overall rate of 10.9% across the eight studies that reported it.
• Lunate revascularization was observed in 78% of patients across the four studies that included imaging follow-up.

Retrospective case series of 7 patients across 11 ultrasound-guided BTX-A treatment sessions (100-150 units per foot) for refractory ischemic Raynaud's phenomenon of the feet, with 6-week clinical assessment of ulcer status, gangrene, and pain.

• At six weeks, 81.8% of treatment episodes demonstrated resolution of ulcers and/or gangrene.
• The proportion of pain-free cases rose from 9.1% to 63.6% following treatment (p=0.013).
• Only one transient adverse event was reported across the 11 injection sessions.

Sub-analysis of the RE-ENERGIZE trial dataset including 1200 patients with second- and/or third-degree burns expected to require grafting, using multivariable logistic regression and dominance analysis to rank comorbidities by their contribution to mortality across three age strata (<50, 50-79, and 80+ years).

• In patients under 50, neurological comorbidities and malignancy were the comorbidities significantly associated with mortality.
• In the 50-79 group, vascular disease, particularly hypertension, dominated the ranking, alongside diabetes and neurological illness.
• In patients aged 80 and older, pulmonary disease (almost entirely COPD) conferred the highest mortality risk.

Case-control study of 30 former burn patients and 30 non-injured controls examined manual dexterity (Purdue Pegboard) and motor cortex physiology (TMS-derived MEP amplitude, short- and long-interval intracortical inhibition) before and after paired-associative stimulation, 1-3 years after burns averaging 0.78% TBSA.

• Former burn patients performed worse than controls on the bimanual assembly subtest of the Purdue Pegboard.
• Paired-associative stimulation did not change MEP amplitude but increased long-interval intracortical inhibition (LICI) in both burn patients and controls.
• Baseline LICI showed a different relationship to bimanual performance in burn patients than in controls, suggesting altered cortical inhibitory processing.

Cross-sectional study of 80 burn scars (40 skin-grafted and 40 delayed-healing) with matched uninjured controls compared transepidermal water loss against scar colour, elasticity, and POSAS-O ratings using two different TEWL measurement devices.

• Delayed-healing scars exhibited significantly higher TEWL than skin-grafted scars, with both scar types elevated above normal skin.
• TEWL normalized at approximately 9.1 months in skin-grafted scars versus roughly 15 months in delayed-healing scars.
• Increased TEWL correlated positively with POSAS-O scores, vascularity, erythema, and elasticity measurements, supporting its role as an indicator of scar activity.
• The two TEWL measurement devices showed strong overall agreement but diverged at the extremes of the measurement range.

This prospective single-center observational study of 60 adult burn ICU patients compared the flow-cytometry-based Intensive Care Infection Score (ICIS) with CRP, procalcitonin, WBC, LBP, presepsin, and calprotectin for distinguishing infection from non-infectious systemic inflammation. Infection status was adjudicated using a composite clinical reference standard incorporating microbiology, imaging, and antimicrobial decisions.

• ICIS achieved an AUC of 0.81 (95% CI 0.69-0.92) for infection discrimination, the highest among all biomarkers evaluated.
• Patient-level analysis showed greater separation between infected and non-infected patients for ICIS than for any conventional biomarker tested.
• Conventional inflammatory markers such as CRP and procalcitonin demonstrated lower discriminatory performance in this burn cohort, consistent with their known nonspecific elevation after thermal injury.

This retrospective single-center review of 2048 pediatric burn outpatient encounters between January 2023 and October 2024 evaluated care interventions generated by weekly multidisciplinary rounds involving physical and occupational therapists, social workers, burn clinic nurses, psychologists, advanced practice providers, and surgeons.

• Multidisciplinary rounds identified 401 care interventions in 215 patients, with 46% involving additional PT/OT, 33% psychosocial needs, and 21% coordination of care.
• Clinic no-show rate during the study period was 13.4%, improved compared with prior years but not statistically significant.
• Average time from compression garment order to delivery was 32.4 days, highlighting a durable supply-chain bottleneck despite improved care coordination.

This preclinical in vitro and in vivo animal study characterized human umbilical cord mesenchymal stem cell-derived exosomes (hUCMSC-exosomes) and tested their combination with low-intensity pulsed ultrasound (LIPUS) in chronic burn wounds infected with methicillin-resistant Staphylococcus aureus.

• Combined exosome plus LIPUS treatment upregulated miR-21, EGF, VEGF, and TGF-β while suppressing PI3K/AKT signaling in human skin fibroblast and HMEC-1 cultures.
• In MRSA-infected burn wounds, the combination accelerated epidermal regeneration and reduced IL-1β, IL-6, IL-12, and CRP on histopathology.
• LIPUS appeared to enhance exosome bioavailability, potentially compensating for the short in vivo half-life that has limited prior exosome-based therapies.

This systematic review and meta-analysis of 16 RCTs compared shorter versus longer durations of postoperative wound coverage with respect to surgical site infection (SSI) rates across heterogeneous surgical populations.

• Pooled SSI risk did not differ significantly between shorter and longer dressing durations (RR 0.84, 95% CI 0.57-1.22, p = 0.33).
• The direction of effect was inconsistent across trials: nine studies favored shorter coverage, three favored longer coverage, and one showed equivalence.
• Overall certainty of evidence was rated GRADE very low, driven by heterogeneity in patient population, surgery type, and dressing duration.

This narrative review synthesizes current understanding of extracellular vesicles (EVs) in burn pathophysiology, focusing on their roles in immune regulation, tissue repair, and clinical applications as biomarkers and candidate therapeutics.

• EVs transport proteins, RNA, metabolites, and cytokines that mediate intercellular signaling in post-burn inflammation and immune response.
• Early studies suggest EV cargo signatures may correlate with burn severity and prognosis, supporting development as bedside biomarkers.
• Preclinical evidence points to a therapeutic potential of MSC-derived EVs for accelerating wound healing, though clinical translation remains limited.

This prospective longitudinal cohort study of children under five with non-severe burns compared post-burn plasma lipidomic profiles, acute-phase glycoproteins (GlycA, GlycB), and hair cortisol against age-matched non-burn controls from the ORIGINS cohort.

• Females showed persistent elevation of arachidonic acid (FA 20:4) and depletion of monoacylglycerols more than one year post-injury, whereas males did not.
• Acute-phase GlycA and GlycB were significantly higher in females around the time of injury compared with male burn survivors.
• Hair cortisol variability increased over time in female survivors but not in males, suggesting a sex-specific pattern of stress dysregulation.

This descriptive single-center review of 145 skin donors between January 2019 and December 2024 reports the operating procedures, donor characteristics, and inventory outcomes of the National Skin Bank of Taiwan.

• Total harvested skin reached 499,231 cm² with 431,666 cm² stored after processing losses of 67,565 cm².
• Annual storage volume grew from 27,345 cm² to 86,333 cm², enabling allograft self-sufficiency from 2020 onward.
• Bacteriological screening showed a 12.88% average donor contamination rate, underscoring the importance of microbiological surveillance in skin banking.

PRISMA-registered systematic review and meta-analysis of 10 observational studies (281 patients) evaluating targeted nipple-areola complex reinnervation after gender-affirming chest surgery or oncologic/prophylactic mastectomy, with random-effects pooling of Semmes-Weinstein monofilament thresholds across three comparative cohorts.

• The pooled Semmes-Weinstein threshold favored TNR by -1.40 monofilament units (95% CI -1.95 to -0.86; I² 58.1%), with a similar gender-affirming subgroup effect of -1.54.
• In the largest comparative cohort with quantitative sensory testing, NAC cold detection differed by 11.1 °C (95% CI 7.6 to 14.6), and 2-point discrimination was present in 40% of TNR nipples versus 0% of controls.
• A nipple-erection substudy reported erection in 73% (16/22) of TNR nipples versus 39% (7/18) of controls.

This prospective cohort of 281 breast cancer patients undergoing axillary lymph node dissection compared perometer, tape measure, and bioimpedance spectroscopy (L-Dex) for diagnosing lymphedema across more than 1100 follow-up measurements over a median 2.3 years.

• Two-year lymphedema rates were 21.9% by perometer, 34.6% by tape measure, and 67.5% by L-Dex.
• Diagnostic agreement was weak between L-Dex and the volumetric methods (κ = 0.28-0.29), and only moderate between perometer and tape measure (κ = 0.51).
• Pearson correlations between modalities were moderate (R = 0.57-0.67), indicating that the choice of measurement modality substantially influences who is labelled with lymphedema.

A retrospective single-center cohort of 787 patients (1,093 breasts) undergoing immediate implant-based breast reconstruction between 2018 and 2024 compared prepectoral direct-to-implant, submuscular direct-to-implant, and two-stage expander techniques using unadjusted analyses and inverse-probability-of-treatment weighting.

• Weighted major-complication rates were similar between prepectoral and submuscular direct-to-implant (7.3% vs 8.4%, p=0.278), while two-stage expanders had the lowest adjusted risk at 0.7%.
• In the post-mastectomy radiotherapy subgroup, prepectoral direct-to-implant showed significantly lower infection than submuscular (2.7% vs 14.3%, p=0.020), without increased dehiscence or seroma.
• Capsular contracture was markedly less frequent with prepectoral placement, with adjusted OR 9.03 for submuscular and 3.25 for expanders relative to prepectoral as reference.

A retrospective single-institution study of 178 patients undergoing DIEP flap breast reconstruction between 2018 and 2023 compared intraoperative ultrasound-guided TAP blocks performed with liposomal bupivacaine versus 0.25% bupivacaine plus 1 mg dexamethasone.

• Length of stay was shorter with bupivacaine plus dexamethasone (2.88 vs 3.49 days, p<0.001).
• Total postoperative opioid use was lower with bupivacaine plus dexamethasone (70.6 vs 104.7 morphine milligram equivalents, p<0.001).
• POD1 pain scores favored the bupivacaine-dexamethasone group (3.44 vs 4.53, p<0.001), with no differences observed on POD 2 through 4.

A ten-year retrospective cohort of 63 patients (89 breasts) compared indications and outcomes of DIEP flap conversion after complicated implant-based reconstruction, stratified by prior post-mastectomy radiation.

• Permanent implant-to-DIEP conversion occurred in 3.7% of the original implant cohort (63 of 1,684 patients), with 37% of converted breasts previously radiated.
• Radiated breasts had higher rates of pre-conversion infection (25% vs 7%, p=0.02) and implant removal (34.4% vs 7%, p=0.002).
• Flap survival was 100% in radiated and 96.5% in non-radiated breasts (p=0.53), with capsular contracture the leading indication for conversion overall.

A retrospective cohort of 243 patients (486 breasts) undergoing primary breast augmentation between 2018 and 2019 compared four pocket irrigation strategies: 0.025% hypochlorous acid, antibiotic with povidone-iodine, antibiotic alone, and chlorhexidine.

• Capsular contracture rates were 0% with hypochlorous acid, 2.3% with antibiotic plus povidone-iodine, 1.7% with antibiotic alone, and 0% with chlorhexidine.
• Severe infection rates were 1.2% with hypochlorous acid, 0.4% with antibiotic plus povidone-iodine, 0% with antibiotic alone, and 1.2% with chlorhexidine.
• Mild infection was 0% in the hypochlorous acid group versus 0.5%, 1.7%, and 0% in the comparator groups.

A cross-sectional survey of 235 women recruited through online patient communities ranked sensory modalities before and after breast reconstruction and assessed awareness and consideration of nerve optimization procedures.

• Tactile sensation was recalled as most important preoperatively (55%), while erogenous sensation was most missed postoperatively (49%).
• Over half of participants (54%) were unaware of nerve optimization procedures but reported they would have considered them if informed.
• Awareness and consideration of nerve optimization were independently associated with higher BREAST-Q Satisfaction with Breasts (p=0.04), along with greater decision confidence and information satisfaction.

A single-center cohort study of 91 patients undergoing unilateral abdominal-based free flap breast reconstruction between 2016 and 2023 compared BREAST-Q outcomes between simultaneous and secondary contralateral symmetrization, using prospectively collected questionnaires.

• Three-month change in Satisfaction with Breasts was significantly higher with simultaneous symmetrization (p=0.011) among patients undergoing delayed reconstruction.
• At two years, after all patients had been symmetrized, satisfaction with breasts did not differ between simultaneous and secondary timing groups.
• Simultaneous symmetrization extended index operative time modestly (371.8 vs 337.6 minutes, p=0.036) but reduced additional operations under general anesthesia (p=0.007), with no significant complication difference.

A systematic review of 29 studies on superficial inferior epigastric vein recipient vessel selection for DIEP flap supercharging, paired with a single-institution clinical practice review of prophylactic cephalic vein anastomosis spanning over two decades.

• The internal mammary vein was the most frequently reported extra-flap recipient, with cephalic, thoracoacromial, and thoracodorsal veins also described.
• Intra-flap options included anastomoses to branches or the caudal deep inferior epigastric vein, and three studies reported use of interposition grafts.
• Eight studies proposed selection algorithms with no consensus, while the reporting institution favored prophylactic cephalic vein anastomosis via a short axillary-fold incision.

A single-institution retrospective review of 270 patients undergoing breast augmentation assessed whether aberrant scarring disorders or specific surgical techniques predicted clinically significant capsular contracture within two years, using Fisher exact tests and Cox regression.

• Clinically significant capsular contracture developed in 10.7% of patients (29 of 270) within two years of surgery.
• Keller Funnel use was significantly more common among patients without capsular contracture (p<0.01).
• No association was found with history of Dupuytren disease, hypertrophic scars, or keloids, nor with sizer use, antibiotic irrigation, Irrisept, or povidone-iodine.

A prospective randomized intrapatient trial of 50 patients undergoing bilateral upper blepharoplasty by a single oculoplastic surgeon compared intradermal versus continuous external 6-0 nylon closure, with blinded photographic evaluation at day 7 and 6 months and POSAS Observer scoring.

• At postoperative day 7, one blinded evaluator favored intradermal sutures in 60% of cases (P = .013), while the second evaluator found no significant difference between techniques.
• POSAS Observer scores showed no statistically significant differences between suturing techniques at either day 7 or 6 months.
• Patient-reported satisfaction was high, with 80% rating their result as "much improved" or "very much improved" on the Global Aesthetic Improvement Scale.
• No suture-related complications were identified; a single unilateral dehiscence could not be attributed to either technique.

A retrospective single-center series of 341 consecutive East Asian patients undergoing deep neck lifting evaluated complication profiles after submandibular gland reduction (n = 240), parotid-tail minimal shaving (n = 81), or both (n = 20), with follow-up of up to 6 months.

• General surgical complications were uncommon: hematoma in 1.17%, infection in 0.88%, and seroma in 1.76%.
• Transient cervical-branch weakness occurred in 1.47% and marginal mandibular nerve weakness in 0.59%, with no permanent nerve injuries observed.
• Gland-specific sialocele was rare, occurring in 0.29% after SMG reduction and 0.88% after parotid-tail shaving.

A prospective consecutive series of 166 patients undergoing primary subfascial breast augmentation was assessed with ten standardized anthropometric measurements and BREAST-V volume estimates before surgery and at 3 months postoperatively.

• Mean volumetric asymmetry fell from 13.6% to 8.1% at 3 months (p < 0.001), while most linear shape measurements were largely unchanged.
• Inframammary crease position became slightly more asymmetric after surgery (+0.18 cm; p = 0.001), the single linear measurement to worsen.
• The sternal notch-to-nipple distance was the most informative single measurement for predicting volumetric asymmetry both before and after surgery.
• Preoperative measurements alone did not reliably identify which patients would achieve excellent postoperative symmetry.

A prospective comparative study of postoperative aesthetic surgery tourists on commercial flights longer than 4 hours monitored oxygen saturation, heart rate, and popliteal vein diameter, with comparison to a control group of nonsurgical travelers.

• All postoperative patients experienced oxygen desaturation of 4-7% within the first 4 hours of flight.
• Heart rate rose by 15-20 bpm in all participants, and popliteal vein diameter progressively expanded over flight duration owing to hypoxia-induced vasodilation and prolonged sitting.
• Postoperative patients had significantly lower baseline hemoglobin than their presurgical values, compounding the hypoxic stress of cabin altitude.
• These combined physiological shifts overlap with risk factors for thrombosis, flap necrosis, infection, and postoperative bleeding, though clinical outcomes were not directly correlated.

A retrospective observational study of 186 patients with clinically relevant post-inflammatory hyperpigmentation after VASER ultrasound-assisted liposuction compared Q-switched Nd:YAG laser alone (n = 93) with 20 sessions of hyperbaric oxygen followed by the same laser protocol (n = 93), with at least 6 months of follow-up.

• Both groups achieved significant PAHPI reduction, but the HBOT-plus-laser group showed significantly greater improvement than laser alone (p < 0.001).
• Treatment response was best for the abdomen and back, while lower limbs retained higher residual pigmentation.
• Within the combined group, larger lipoaspirated volume was inversely correlated with PAHPI reduction (p < 0.001), suggesting more extensive procedures responded less completely.
• No increase in adverse events was reported with the addition of HBOT.

A single-surgeon retrospective review of 350 consecutive patients undergoing drainless lipoabdominoplasty between 2017 and 2024 evaluated complication rates after a combined protocol of progressive tension sutures, Scarpa's fascia preservation, and minimal cautery.

• The overall complication rate was 9.1% (32 of 350), with all patients recovering without sequelae and no mortalities.
• The postoperative seroma rate was 2%, comparing favorably with published drain-based series.
• The cohort spanned 286 full abdominoplasties, 50 belt lipectomies, and 14 modified float abdominoplasties, suggesting the drainless protocol generalizes across truncal contouring variants.

A self-controlled longitudinal cohort of 90 patients with documented recurrent herpes labialis undergoing serial HA lip augmentation between 2016 and 2025 used each participant as their own control, with recurrence modeled by negative binomial generalized estimating equations.

• Baseline recurrence was 5.22 episodes per person-year, with no significant change after the first filler session.
• After the second session, recurrence dropped significantly (IRR 0.81, 95% CI 0.72-0.91; P < .001).
• After four sessions, the rate ratio fell to IRR 0.55 (95% CI 0.45-0.66); P < .001, after which recurrence stabilized.
• The authors stop short of inferring causality and explicitly call for further investigation of the temporal pattern.

A retrospective claims-based cohort of 1,340,450 adult CPAP initiators with obstructive sleep apnea compared 180-day CPAP discontinuation across five nasal surgical cohorts and a no-surgery reference using Cox regression with coarsened exact matching and multiple sensitivity analyses.

• Overall CPAP discontinuation was 29.0%, with 1-year persistence of 84.2% after TCRF versus 76.1% without nasal surgery.
• TCRF showed the strongest association with continued CPAP use (HR 0.62, 95% CI 0.53-0.72), strengthening to HR 0.48 after inverse probability of censoring weighting.
• Other procedures showed more modest associations: combined functional rhinoplasty plus septoplasty HR 0.84, other nasal surgery HR 0.86, septoplasty HR 0.87, and functional rhinoplasty alone HR 0.90 with the confidence interval crossing 1.
• The TCRF association was consistent across insurance types and sensitivity analyses, with an E-value of 2.61 suggesting moderate robustness to unmeasured confounding.

Single-center retrospective case series of 11 patients (8 women, 3 men; mean age 59 years) presenting to a tertiary salivary gland clinic with obstructive sialadenitis after facial rejuvenation, all managed with sialendoscopy and followed for a mean of two years.

• Physical examination localized parotid involvement in 8 cases and submandibular gland involvement in 3, with symptoms ranging from swelling and pain to xerostomia, hypersalivation, and pruritus.
• Preoperative imaging showed ductal dilation and strictures, while intraoperative findings characteristically revealed a convoluted and atrophic ductal system with cloudy sediments.
• Most patients required multiple sialendoscopic procedures, but the majority were successfully managed endoscopically without open intervention.
• One patient with a persistent parotid cutaneous fistula required adjunctive open repair using a sternocleidomastoid muscle flap.

MAUDE database analysis of 1.8 million procedures performed with 14 FDA-approved liposuction and noninvasive fat-reduction devices between 2020 and 2025, cross-referenced with ASPS annual procedure volumes for 6 devices.

• Across all devices, 642 complaints were logged, yielding an overall reported complication rate of 0.04%.
• Cryoliposuction accounted for 72.7% of complaints (467/642), with 99% linked to paradoxical adipose hyperplasia.
• Ultrasound-assisted liposuction generated 13% of complaints; 54% reflected machine malfunctions, including cannula-tip breakage in 25.5%.
• Among the broader complaint pool, paradoxical rebound (71%) and burns (8.1%) were the most frequent issues.

Single-center retrospective case series of 15 patients (mean age 36.3 years) who underwent spare-part reconstruction with fillet flaps or rotationplasties after sarcoma surgery between 2014 and 2025, with mean follow-up of 37.2 months.

• All 15 flaps survived, with 6 patients experiencing postoperative complications.
• At study end, 9 patients were alive (8 with no evidence of disease, 1 with progression) and 6 had died at a mean of 26.7 months after surgery.
• Mean disease-free survival was 10.4 months, and prosthesis fitting occurred at a mean of 4 months postoperatively.
• The reconstructive repertoire included 5 upper-limb and 4 lower-limb fillet flaps, 1 hip rotationplasty, and 5 knee rotationplasties across diverse resections.

Narrative review of 2025 advances in radiotherapy for soft tissue sarcoma, synthesizing technological, fractionation, combination, and personalization developments without formal quality appraisal.

• Preoperative moderately hypofractionated radiotherapy for extremity and superficial trunk sarcomas is supported by prospective and real-world data showing non-inferior local control with acceptable toxicity.
• Stereotactic body radiotherapy and particle therapy have expanded roles in recurrent, metastatic, and pediatric sarcoma populations.
• Combinations with targeted agents such as PARP inhibitors and pazopanib, as well as immunotherapy, show synergy particularly in high-risk subtypes.
• Multiparametric MRI and pathological biomarkers such as hyalinization and tumor-infiltrating monocytes are enabling adaptive, response-guided radiotherapy.

Descriptive technical case series of 5 vignettes illustrating a pentagonal V-Y design modification of the pedicled latissimus dorsi myocutaneous flap for chest wall reconstruction after sarcoma resection, accompanied by a literature summary.

• The pentagonal geometry is designed to maximize the skin paddle and avoid unnecessary skin bridges.
• The modification preserves V-Y advancement as an inset option rather than committing to conventional rotational inset.
• Authors describe a broader and wider flap harvest while minimizing the risk of donor-site closure failure.
• The technique aims to import nonirradiated, well-vascularized tissue into previously irradiated defects.

Observational case-control study of 17 patients with prosthetic knee reconstruction after bone sarcoma and 18 matched healthy controls, comparing sagittal-plane gait kinetics on a force-instrumented treadmill at preferred and matched walking speeds.

• Patients walked at a slower preferred speed than controls.
• At matched speeds, patients showed lower peak knee extensor moments, with the gap widening at faster speeds.
• At the fastest walking speed, patients also demonstrated lower peak knee joint power than controls.
• The kinetic differences are interpreted as reflecting an inability to generate equivalent knee extensor force rather than a purely kinematic adaptation.

PRISMA-compliant systematic review of 55 studies (from 12,316 screened, published 2009-2025) examining clinical applications of artificial intelligence, augmented reality, and robotics in surgical and non-surgical aesthetic procedures.

• AI-based image analysis dominated the literature (60%, n=33), supporting objective skin assessment, volumetric planning in breast and facial surgery, and patient communication.
• Robotics (16%, n=9) addressed facial, mandibular, hair, and laser procedures, with some studies reporting precision exceeding manual techniques.
• Augmented reality (15%, n=8) was applied to intraoperative navigation and preoperative simulation.
• Methodological quality was overall low-to-moderate, with workflow integration limited by dataset diversity, cost, and ethical oversight.

Single-center retrospective cohort of 365 patients admitted to a burn ICU in 2023, evaluating the LDH/lymphocyte (LDH/LYM) ratio as a survival predictor using regression, ROC, Kaplan-Meier analysis, and a LightGBM machine-learning model.

• Multivariate analysis identified age, TBSA, and the LDH/LYM ratio as independent prognostic factors.
• AUCs were 0.785 for LDH/LYM and 0.814 for TBSA alone, rising to 0.88 when combined.
• An LDH/LYM cutoff of 186.361 separated survival curves between high- and low-ratio groups (HR 0.074, p<0.001).
• The LightGBM model ranked TBSA, BUN, and LDH/LYM as top predictors and achieved an AUC of 0.916 with overall accuracy of 0.849.

TIGER was an international open competition to benchmark deep-learning models that quantify tumor-infiltrating lymphocytes (cTILs) on H&E whole-slide images, evaluated on a multi-centric cohort of 3,708 HER2+ and triple-negative breast cancers from clinical practice and phase 3 trials. The analysis compared cTILs against expert visual scoring for agreement, response prediction, and prognostic value.

• Across resections and biopsies, the top cTILs algorithms showed strong agreement with expert pathologists, supporting cTILs as a reproducible quantitative readout.
• In HER2+ disease, cTILs were positively associated with response to neoadjuvant therapy and outperformed visually scored TILs as a predictive biomarker.
• In triple-negative resections, cTILs added independent prognostic information beyond standard clinical variables on multivariable analysis.
• The competition released open-source models, data, and benchmarks at tiger.grand-challenge.org to support external validation and downstream use.

Single-center diagnostic and clinical comparison study developing a Flap Segmentation Network deployed as a smartphone app for real-time free flap monitoring, trained and validated across three phases on a dataset of 1,649 photographs from 615 patients undergoing free flap reconstruction. A subsequent clinical phase compared the system against standard ward-based monitoring in 113 patients.

• On external validation the model reached accuracy 89.3%, sensitivity 96.2%, specificity 84.9%, AUC 0.93 for detecting venous congestion.
• In the clinical application phase, the system performed at 92.16% accuracy with a 4.82% false-negative rate under routine use.
• Compared with conventional monitoring, the remote-monitoring arm showed shorter time to congestion detection, shorter time to re-exploration, and higher flap survival, although none reached statistical significance.
• The platform operated on standard smartphones via TensorFlow Lite, suggesting feasibility for ward and outpatient deployment without dedicated hardware.

Development and internal validation of FlapCheck.ai, a Microsoft Azure Custom Vision classifier trained on a single-center retrospective dataset of 209 labeled flap images (expanded to 1,432 with augmentation) drawn from chart review and the published literature. Performance was assessed on a held-out 20% test set with class balance preserved.

• On the test set, the model correctly classified 40 of 41 images, with accuracy 97.6% and AUC 0.997.
• Sensitivity for compromised flaps was 100% (95% CI 72.2-100), with specificity 96.8% and precision 90.9%.
• The system handled nonstandardized clinical images without rigid lighting or framing requirements, supporting potential outpatient or smartphone use.
• Performance was achieved using a no-code commercial vision platform, lowering the barrier to local training and deployment.

Mechanistic preclinical study combining single-cell and bulk RNA-seq, rabbit ear hypertrophic scar models, and patient tissue analysis to test whether endothelial TRPV1 signaling drives angiogenesis in hypertrophic scar (HS). In vitro endothelial assays and a rabbit ear HS model with capsaicin stimulation versus TRPV1 ablation were used to interrogate the pathway.

• Single-cell sequencing revealed marked endothelial heterogeneity and activated angiogenesis programs in HS compared with normal skin.
• Topical capsaicin exacerbated scar thickness and vascularity in rabbit ears, whereas genetic or pharmacological TRPV1 inhibition attenuated the phenotype.
• TRPV1 activation promoted endothelial proliferation, migration, and tube formation via a NF-κB-dependent IL-6/STAT3 axis.
• In patient samples, dermal expression of the TRPV1/NF-κB/IL-6 axis correlated with HS severity and recurrence, supporting translational relevance.

Preclinical biomaterial study developing and testing a gelatin hydrogel combining mesenchymal stem cell exosomes and nanocurcumin in vitro and in a rat deep second-degree burn model versus exosome-only, nanocurcumin-only, and control dressings. Outcomes included wound closure, histology, and angiogenesis markers.

• In vitro, the dual-loaded hydrogel enhanced fibroblast proliferation, migration, and angiogenesis beyond either single component.
• In rats, treated wounds showed faster wound closure with thicker granulation tissue and increased collagen deposition than controls.
• Histology and immunohistochemistry confirmed improved re-epithelialization and neovascularization in dual-loaded versus comparator dressings.
• Treatment was associated with reduced local inflammation, consistent with the proposed exosome-driven immunomodulation.

Laboratory protocol study comparing storage temperatures, formats, and thawing strategies for excised human fat across 22 donors and 284 technically replicated experiments, evaluating oil release, SVF yield and viability, and ADSC differentiation potential. Tissue blocks and lipoaspirates were stored at -20°C or -80°C for up to four months and benchmarked against fresh controls.

• Rapid thawing at 37°C minimized oil leakage and preserved SVF yield, outperforming slower thawing protocols in tissue blocks.
• After four months, -80°C tissue blocks retained 88% of SVF cells with 68% viability and 70-80% CD73/CD90/CD105 expression.
• ADSCs from -80°C blocks differentiated into adipogenic, chondrogenic, and osteogenic lineages, whereas -20°C samples failed to adhere or differentiate.
• Tissue blocks consistently outperformed lipoaspirates for SVF recovery per gram of fat under the same conditions.

Bioinformatics study integrating ECM-related gene lists with eQTL, mQTL, and pQTL datasets in a summary-data-based Mendelian randomization analysis using FinnGen as the discovery cohort and UK Biobank plus GWAS Catalog data for replication, supplemented by colocalization analysis. The goal was to identify ECM-related genes causally linked to skin fibrosis risk.

• Discovery analysis flagged 329 mQTLs, 15 eQTLs, and 11 pQTLs, with colocalization confirming 228, 9, and 9 signals, respectively.
• Hypomethylation at cg18814314 of HSF1 was associated with increased HSF1 expression and protein levels and higher skin fibrosis risk.
• Signals were replicated across independent GWAS resources, supporting robustness beyond the FinnGen discovery cohort.
• Findings position HSF1 as a novel candidate target for mechanistic and therapeutic study in fibrotic skin disease.

Mechanistic study using retrograde tracing, single-cell RNA sequencing of dorsal root ganglion neurons, and three complementary surgical and transgenic mouse tendinopathy models to define how somatosensory innervation shapes tendon disease. Findings were extended to organ culture and human tendinopathy specimens.

• Sensory neurons, including CGRP+ nociceptors, invaded the tendon proper during tendinopathy and engaged tenocytes and macrophages.
• Macrophage-specific Ngf deletion or TrkA inactivation worsened tendinopathic changes, as did sural nerve denervation, with increased macrophage infiltration and tenocyte apoptosis.
• Ligand-receptor analysis and functional assays identified neuron-derived FGF1 as a protective factor against tendon degeneration in vitro and in vivo.
• Human tendinopathy specimens showed FGF1 immunoreactivity along intratendinous nerve fibers, consistent with a conserved mechanism.

An RNA-Seq transcriptome study of 17 keloid and 8 normal skin samples from a single Chinese hospital was paired with multi-platform bioinformatic pathway analysis. RT-qPCR was used to confirm a subset of differentially expressed genes.

• Analysis identified 2,610 differentially expressed genes at FDR < 0.01, with keloid and normal skin clustering separately on principal component analysis.
• Top canonical pathways were oxidative phosphorylation, mitochondrial dysfunction, and sirtuin signaling, concordant across IPA and KEGG outputs.
• Upstream regulator analysis showed upregulation of TP53, TLE3, UQCC3, ClpP, and TGFβ1, with downregulation of CPT1B, insulin signaling, INSR, and PPARGC1A.
• DEG profiles correlated strongly with published skin disease expression datasets queried through the Illumina BaseSpace Correlation Engine.

A mechanistic mouse study using conditional endothelial genetics combined receptor-specific VEGF ligands and in vivo imaging to dissect how VEGFR2, VEGFR3, and PI3Kα coordinate lymphatic endothelial proliferation versus sprouting.

• Endothelial VEGFR2 loss abolished sprouting but spared proliferation in response to VEGF-C, whereas VEGFR2 activation alone was insufficient to drive lymphangiogenesis.
• Deletion of the VEGFR3 downstream effector PI3Kα completely abrogated lymphangiogenesis, identifying it as the dominant intracellular node in this pathway.
• VEGFR2 and VEGFR3 were found in close proximity on lymphatic endothelium, with VEGF-C increasing surface VEGFR2 relative to VEGFR3 to prime cells for sprouting.

A preclinical mouse skin wound study tested whether dense, clinically approved nanoparticles incorporated into mesenchymal stem cells could accelerate gravitational settling and improve engraftment. A copper-chaperone-activatable variant was further evaluated for regenerative signaling.

• Nanoparticle incorporation increased cellular density and gravitational settling, improving adhesion and survival of transplanted mesenchymal stem cells.
• Copper-chaperone-activatable nanoparticles activated fibroblast growth factor 2 and engaged a positive-feedback loop driving regenerative and anti-fibrotic signaling.
• In cutaneous wounds, nanoparticle-treated stem cells produced enhanced vascularization and reduced fibrosis compared with untreated cells.

A rat sciatic nerve defect study with 10 animals per group compared bisvinyl sulfonemethyl-crosslinked gelatin nerve guidance conduits combined with no, 2 Hz, 20 Hz, or 200 Hz electrical stimulation over 4 weeks. Morphometry, electrophysiology, retrograde tracing, qPCR, and behavioral testing were assessed.

• 2 Hz stimulation produced significantly greater axon number, axonal density, and regenerated nerve area than control and higher-frequency groups.
• Electrophysiology under 2 Hz showed improved conduction velocity, higher MAP amplitudes, and shorter latencies, consistent with the morphometric gains.
• Low-frequency stimulation upregulated neurotrophic factors, increased macrophage recruitment, and elevated CGRP, indicating coordinated neuroimmune and neurotrophic activation.
• 200 Hz stimulation failed to enhance regeneration and reduced axonal metrics, consistent with overstimulation-associated suppression.

A rat experimental study of 27 animals in three groups tested whether single- or double-layer silicone-induced capsule prelamination around femoral vessels could create a vascularized chondrocapsular construct when autologous auricular cartilage was inserted between the layers. Vascularity and chondrocyte viability were assessed by histology and immunohistochemistry.

• Capsule formation occurred only in the silicone-prelaminated groups; direct cartilage implantation produced no capsule.
• The double-layer capsule group showed the strongest neovascularization, while the single-layer group had the highest chondrocyte viability.
• CD31, CD44, and Col2A1 staining confirmed superior vascularity and chondrogenic activity in both prelaminated groups versus controls.